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Soccer exposes players to head injuries and involves repeated intentional head impacts through heading the ball. Our objective was to investigate the rate of both intentional headers and involuntary head impacts in semiprofessional male soccer players during one season. In this prospective cohort study, we followed 54 men (16-35 years) playing in two soccer clubs participating in the same regional French championship throughout the 2017-2018 season. All head impacts that occurred in competitive games were analyzed using video recordings. Player position, game exposure, referee's decision were also reported. Head impact incidence rate (IR) per 1000 player-hours, with the 95% confidence intervals (CIs) were calculated. Results: Headers IR was 3584.7 per 1000 player-hours (95% CI = 3431.9, 3737.5). Forwards and center-backs performed a higher number of headers. Involuntary head impacts IR was 44.1/1000 player-hours (95% CI = 27.1, 60.9). Just under half led the referee to stop playing time for a caregiver examination. Three concussions with a loss of consciousness after a head-to-head impact in a heading duel were recorded. Conclusions: Intentional headers were relatively common, contrary to involuntary head impacts that were however mainly due to heading duels. Head-to-head impact should lead to a systematic exit from the game for suspicion of concussion.

Resume Introduction La prevention des lesions du ligament croise anterieur (LCA) passe par la realisation pluri-hebdomadaire de protocoles d’echauffement multimodaux. Dans une etude de 2015, Khayambashi a retrouve une association entre la faiblesse des muscles rotateurs externes et abducteurs de hanche, et le risque de lesion du LCA sans contact. Objectif Notre objectif etait de mesurer l’evolution de la force des muscles rotateurs externes et abducteurs de hanche depuis la mise en place d’un protocole de preparation multimodale adapte depuis le FIFA 11+ (tendant ainsi a diminuer le risque de lesion du LCA sans contact). Methode Nous avons effectue un suivi observationnel prospectif de l’equipe feminine professionnelle du FC Girondins de Bordeaux entre juillet 2018 et mai 2019. Des mesures de force des muscles rotateurs externes et abducteurs de hanche ont ete realisees en debut et en fin de saison depuis l’introduction d’un protocole de preparation multimodale. Resultats Nous avons retrouve une augmentation significative de la force des muscles abducteurs de hanche de 17,12 % du cote dominant et de 6,90 % du cote non dominant, ainsi qu’une augmentation significative de la force des rotateurs externes de hanche de 16 % du cote dominant (avec une tendance a l’augmentation de 8,68 % du cote non dominant). Les medianes des ratios force/masse corporelle ont egalement evolue favorablement. Conclusion Il semble exister une augmentation de la force des muscles rotateurs externes et abducteurs de hanche depuis l’introduction d’un protocole de preparation multimodale adapte depuis le deroulement FIFA 11+.

Resume Objectif La pathologie musculaire des ischio-jambiers (IJ) est frequente chez le sportif. En revanche, la rupture distale du biceps femoral (BF) est une pathologie rare et peu connue. Quelques etudes ont ete publiees et montrent que le traitement chirurgical semble donner de meilleurs resultats qu’un traitement conservateur, comme c’est le cas dans les ruptures proximales des IJ. Le but de ce travail est de communiquer les resultats fonctionnels d’un joueur de football de haut niveau, opere de cette lesion. Cas clinique Mr D., footballeur du centre de formation du FC Girondins-de-Bordeaux, âge de 18 ans, a presente lors d’un match amical une rupture distale du BF suite a un contact avec un autre joueur. Un traitement chirurgical avec une suture du tendon a ete realise a deux semaines de sa blessure. Le joueur a pu reprendre le football a 5 mois au meme niveau qu’avant sa blessure. A un an de recul, le joueur n’a pas presente de recidive. Discussion L’indication chirurgicale a ete posee devant le role important du BF dans la stabilisation posterolaterale du genou, dans la flexion du genou et au vu des bons resultats fonctionnels postoperatoires decrits dans la litterature. Conclusion La rupture distale du BF est une pathologie rare. Un diagnostic et un traitement chirurgical precoces permettent une reprise rapide de l’activite sportive a haut niveau comme c’est le cas dans les ruptures proximales des IJ.

Background Treatment for patients with chronic low-back pain (LBP) is a public health issue. Intramuscular injections of botulinum toxin A (BoNT-A) have shown an analgesic effect on LBP in two previous randomized controlled studies. The objective of the study was to verify the efficacy of paravertebral injections of BoNT-A in patients with LBP. Methods Patients were included in this phase 3 randomized double-blinded trial comparing the efficacy of BoNT-A versus placebo in a crossover study on LBP. Both groups received 200 units of BoNT-A in paravertebral muscles or a placebo, and vice versa at Day 120. The main judgment criterion was LBP intensity 1 month after the injections, evaluated by using a visual pain scale (VAS). Secondary assessment criteria included: LBP intensity 90 and 120 days after injection day; number of days when an allowed antalgic oral treatment was needed in between each evaluation; functional disability measured by the Quebec Back Pain Disability Scale; quality of life; inability to work; patient satisfaction in relation to the treatment’s effect; spinal mobility; and strength of spinal muscles, measured by isokinetic technique. Results Nineteen patients completed the study. There was no significant difference between the groups’ average LBP during the last 8 days at Day30 (p = 0.97). There was no significant difference between the two groups regarding the secondary assessment criteria (p > 0.05). Conclusions Injections of BoNT-A in the paravertebral muscles were not found to be effective to relieve chronic LBP. The limits of the study are that the dose of BoNT-A used was lower than in other studies, and that the limited number of patients included may explain the negative results. Trial registrations Identifiers: NCT03181802 . Unique Protocol ID: CHUBX2003.

The arrival of new drugs and new therapeutic strategies allowed to reach sustained remission in an increasing number of patients with rheumatoid arthritis. The study of biologic disease-modifying anti-rheumatic drugs (bDMARDs) adaptation strategies is a need to optimize the benefit/risk balance and cost/effectiveness ratio of these molecules. Current recommendations such as EULAR 2016 propose tapering bDMARDs, especially when combined with a csDMARD, when the patient is in remission after stopping persistent glucocorticoids. The analysis of literature comprising 22 studies shows that a bDMARD adaptation is possible in established rheumatoid arthritis when clinico-biological and ultrasound remission is maintained over six months. Priority should be given to a progressive tapering strategy doses controlled by disease activity while maintaining "tight control" to identify and effectively treat a relapse, a retreatment being usually favorable.

Purpose The aim of this study is to evaluate the right atrial (RA) mechanics and change in echocardiographic parameters used for assessment of RA by examining the end stage kidney patients before and after the hemodialysis (HD). Methods Patients between 18 and 85 years of age, receiving HD for at least 6 months were included. The echocardiographic images were obtained before and after hemodialysis therapy. Two-dimensional speckle tracking strain analysis was performed for right atrium in 62 patients. Reference points for analysis are set on the "P" waves. RA reservoir, conduit and contraction phase longitudinal strain (Figure 1) and strain rates (Figure 2) were calculated. The changes in echocardiographic methods before and after hemodialysis were examined. Correlation between volume depletion and change in echocardiographic parameters were calculated. Results 62 patients (49.7 ± 16.9 years of age, 22 women) were included in study. The mean volume of ultrafiltration was 2958.12 ± 1050.5 ml . The chamber sizes RA are decreased after hemodialysis (RA major diameter; 4.74 ± 0.62 cm vs. 4.46 ± 0.54 cm p

Resume Contexte La difficulte de comparer les etudes sur l’isocinetisme vient du nombre important de protocoles d’evaluation, d’une part et, des seuils des ratios utilises d’autre part. Notre premiere etude a montre qu’un protocole d’evaluation « type » est largement utilise par les clubs de football professionnel francais. Cependant, nous constatons egalement que les seuils des ratios pour definir la « norme » sont tres differents. Objectifs Etablir les seuils de reference chez le footballeur de haut niveau de plus de 17 ans en appliquant le protocole « type ». Methodes Pour determiner les seuils de reference, les joueurs du Football Club des Girondins de Bordeaux (FCGB) ont eu un test isocinetique. Les joueurs ayant presente une lesion du membre inferieur dans les 6 mois precedents ont ete exclus. Resultats La valeur de reference, situant le seuil pathologique pour les ratios bilateraux, est de 15 %. Pour les ratios unilateraux, les seuils sont les suivants : RC60° : Conclusion Nous proposons la mise en application de ce protocole « type », en utilisant les seuils indiques ci-dessus pour depister un desequilibre musculaire.

Resume Contexte La lesion musculaire des ischiojambiers (IJ) est la blessure la plus frequente du footballeur. Des les annees 1970, le desequilibre musculaire a ete incrimine comme facteur de risque de lesion. La realisation d’un test isocinetique pour rechercher ce desequilibre s’effectue selon des modalites precises. Mais la difficulte de comparaison des etudes vient d’une part, du nombre important de protocoles d’evaluation et, d’autre part, des seuils des ratios utilises. Objectifs Etablir les differentes modalites d’utilisation de l’isocinetisme, dans les clubs francais de football professionnel. Methodes Au cours du mois de juin 2015, un questionnaire a ete envoye. Le recueil des donnees s’est termine fin aout 2015. Resultats Sur les 62 clubs interroges, 52 ont repondu ; l’isocinetisme est largement utilise (94 %). Un protocole type se degage (42 % l’appliquent) : il s’agit d’un test concentrique a 60 et 240°/seconde pour les quadriceps et les IJ et un test excentrique pour les IJ a 30°/s. Conclusion L’isocinetisme est tres employe par les clubs francais de football professionnel. Nous proposons a l’avenir, la mise en œuvre de ce protocole « type ».

Industrial timber plantations are controversial in many parts of the world including in Indonesia. Knowledge of their perceived impacts is important for better management and integration into the rural landscape. To advance knowledge on this topic, we applied the Q-method to a case study in East Kalimantan province, Indonesia, where a large-scale acacia plantation is established. Three groups emerge from the analysis with contrasting viewpoints: a first group exhibits enthusiasm over the development of the plantation, including recognition of environmental services provided; the two other groups express dissatisfaction, either generally on all aspects or with a focus on the plantation as obstacle to local development. Research has shown that the Q-method needs to be completed by other tools such as household surveys in order to make for its limitations, e.g. assessing representativeness of each group and determinants of inclusion in one given group.

Background CD180, a related member of the Toll-like receptor family, seems to be underexpressed at the plasma membrane in circulating B cells of auto-immune disease (systemic lupus especially),1 and is lost in various B-cell lymphomas except marginal zone lymphomas (MZL), the most severe complication of primary Sjogren’s Syndrome (pSS).2 Objectives To define the expression of CD180 at the plasma membrane of circulating B cells of pSS and determine its association with systemic disease activity. Methods The expression of CD180 at the plasma membrane of circulating B cells was studied by flow cytometry, in 69 successive patients with pSS, in comparison to patients with systemic lupus (SLE) (n=7) and healthy controls (n=28). Results The cohort of pSS was composed of 65 women for 4 men, median age of 59 years.25–89 Median clinESSDAI was 2 [0–18], 46 patients with a clinESSDAI >0 (low disease activity), 18 patients with a clinESSDAI >5 (moderate disease activity) and 6 patients≥14 (high disease activity). The more frequently involved domains of the ESSDAI were biological (39%, n=27), glandular (32%, n=22), articular (20%, n=14), and peripheral neurological (9%, n=6) domains. Fourty patients were anti-SSA+, 16 anti-SSA and anti-SSB+. 18 had a hypergammaglobulinemia, 17 a hypocomplementemia, 7 a cryoglobulinemia, 18 a rheumatoid factor and 9 a lymphopenia. - CD180-negative B cells in pSS, SLE and controls The proportion of total lymphocytes, B cells, T cells, NK cells or CD180-negative B cells (0.85% vs 0.95%, p=0.64) was not significantly different between pSS patients and healthy controls. Patients with SLE had significantly fewer lymphocytes (860 vs 1544, p=0.0012), B cells and T cells than those with pSS (p=0.023 and p=0.0016); CD180-negative B cells tended have a higher proportion in SLE than in pSS patients (1.9% vs 0.85%, p=0.055). - Increase of CD180-negative B cells in patients with pSS and high systemic disease activity CD180-negative B cells subset was significantly higher in patients with high systemic disease activity (2.55% CD180-negative B cells in patients with clinESSDAI ≥14 vs 0.8% in patients with clinESSDAI Conclusions Blood CD180-negative B cells are increased in pSS patients with high systemic disease activity or in immunologically active pSS. Fonctionnality of CD180 and the prognostic interest of CD180 staining on blood B cells to predict lymphoma in pSS patients, have now to be studied. Reference [1] Kikuchi Y, et al. RP105-negative B cells in patients with Sjogren’s syndrome. [2] Mayeur-Rousse C, et al. CD180 expression in B-cell lymphomas: A multicenter GEIL study. Disclosure of Interest None declared

Background Respiratory involvement in rheumatoid arthritis (RA) is the most common extra-articular localisation, affecting 50% of patients, even though only 5% become symptomatic. Lung pathology as RA related interstitial lung disease is associated with significant morbidity and mortality. Involvement of the respiratory system seems frequent but remains underestimated because of the absence of guidelines about its detection in patients with RA. Objectives This study aimed at determining the prevalence of respiratory involvement among symptomatic and asymptomatic patients with rheumatoid arthritis managed in a university hospital. Methods We conducted a prospective observational study from May 2017 to January 2018 at the Strasbourg University Hospital. The patients included were over 18 years of age, had rheumatoid arthritis according to the ACR/EULAR 2010 criteria and signed informed consent. They responded to a self-administered questionnaire about their medical history, cardiorespiratory symptoms and lifestyle. Epidemiological, clinical and radiological data were assessed. All of the patients had a chest computed tomography (CT) and respiratory function tests (RFT). A collection of salivary flow and a test of Shirmer were carried out, to investigate the presence of a sicca syndrome. Chest CTs were interpreted by a radiologist specialised in lung area. Results We included 102 successive patients, 73 women and 29 men. The average disease duration was 34 years. 60 patients were seropositive for rheumatoid factor and 68 for anti-CCP. 59 patients had bone erosions. The average disease activity score (DAS28-CRP) at inclusion was 3.5. 49 patients had associated Sjogren’s syndrome. 22 were active smoker. 43 patients were taking long-term corticosteroid therapy. 96 patients were treated with conventional DMARD treatment, 28 with anti-TNF alpha therapy, 16 with Tocilizumab, 12 with Abatacept, 2 with JAK selective inhibitor, and 16 patients were under Rituximab. Of the 87 RFT performed, 39 were abnormal: 14 reported an obstructive syndrome, 8 a restrictive syndrome, 32 peripheral expiratory braking, suggestive sign of bronchiolitis, and 24 a decrease in the DLCO. Of the 91 chest CTs, 42 revealed lung nodules (42%), 15 of which were more than 6 mm; 29 interstitial syndrome (29%), among which 5 were non-specific interstitial pneumonitis (PINS), 3 common interstitial pneumonitis (PIC), and the other were non specific interstitial syndrome. 2 chest CT showed pleural effusion and 1 pericarditis. 44 patients had coronary calcifications, among whom 32 had no lipid-lowering therapy. Conclusions Pulmonary systemic assessment of RA patients show high prevalence of respiratory involvement: 42% of patients had lung nodules and 29% had an interstitial syndrome. Detection of interstitial lung disease may raise questions about RA treatment such as anti-TNF alpha therapy. Rheumatologist should be more aware of respiratory involvement in RA patients and RFT, a non-invasive test, might be useful at diagnosis and follow-up. Disclosure of Interest None declared

BACKGROUND Botulinum toxin A (BoNT-A) is a novel treatment for chronic lateral epicondylar tendinopathy. Preliminary studies have demonstrated promising results; however, confirmation of the effectiveness of BoNT-A treatment and further assessment of its side effects are required. This study investigated the analgesic effects of BoNT-A in the treatment of chronic lateral epicondylar tendinopathy. METHODS This was a phase-III, single-center, randomized, double-blinded, placebo-controlled study including 60 patients with chronic lateral epicondylar tendinopathy that had been resistant to treatment for >6 months. Patients received either a 40-IU injection of BoNT-A or saline solution placebo into the extensor carpi radialis brevis (ECRB) muscle, aided by electromyographic (EMG) stimulation. Follow-up was 3 months. The primary assessment criterion was the percentage of patients whose pain was reduced by >50% at 90 days after injection. Secondary outcomes, including pain intensity, pain frequency, interference with quality of life, sick leave taken, maximum grip strength, and side effects, were assessed at days 30 and 90, and the number of participants per group requesting additional therapies at day 90 was recorded. RESULTS Twenty-nine patients in the BoNT-A group and 28 patients in the placebo group were included in the day-90 analysis. Fifteen (51.7%) of the patients who were administered BoNT-A and 7 (25%) of the patients who received placebo reported a >50% reduction in initial pain intensity at day 90 (p = 0.005). Pain intensity and the effect on quality of life, measured using visual analog scales, were both significantly lower in the group treated with BoNT-A compared with placebo at day 90 (p < 0.05). The rate of clinically detected transitory paresis of the third finger on extension was 17.2% in the BoNT-A group, with no associated functional impairment. CONCLUSIONS BoNT-A at 40 IU injected into the ECRB is an effective treatment for chronic lateral epicondylar tendinopathy that has been otherwise resistant to medical treatment. The rate of paresis of the third finger was low, with no associated functional impairment. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

International audience; BACKGROUND: Epicondylar tendinopathy ("tennis elbow") is a serious issue in manual labourers. Symptoms can persist over months or even more than 1 year, even when treated with trinitrine patches, acupuncture, sclerosis of neovessels, shock-wave therapy, autologous blood injections, platelet-rich plasma or hyaluronic acid. Botulinum toxin (BoNT-A) injections showed promising short-term results, but the long-term beneficial effects are not yet known. OBJECTIVE: We aimed to assess the long-term effect, side effects and recurrence rate after BoNT-A injections on chronic lateral epicondylar tendinopathy during 1 year. METHODS: This open study followed a 3-month randomized controlled trial. We included 50 patients followed at day 0 (V0), 90 (V1), 180-270 (V2) and 365 (V3). The main judgment criterion was the number of BoNT-A injections required to achieve pain relief with no further request for treatment by the patient. RESULTS: After one BoNT-A injection, 22/50 (44%) patients did not ask for further treatment during follow-up because of complete pain relief, and 20/50 (40%) asked for a second BoNT-A injection. For 20 patients with a second injection, 18 (90%) did not ask for further treatment during follow-up. Only 1 patient had a recurrence of pain after an initial pain relief of greater than 75%. Quality of life, and painful and maximal gripping force improved significantly at V1, V2 and V3 as compared with V0, and repercussions on daily and professional activities decreased significantly (P

A new blind calibration scheme for M time-interleaved analogue-to-digital converters (ADCs), which models gain, time-skew and bandwidth mismatches as components of a transfer function mismatch, is proposed. Numerical results on the emerging generation of WiFI IEEE 802.11.ac with 12-bit ADCs show the effectiveness of the method.

During the past 40 years brain tissue grafting techniques have been used both to study fundamental neurobiological questions and to treat neurological diseases. Motor symptoms of Parkinson's disease are largely due to degeneration of midbrain dopamine neurones. Because the nigrostriatal pathology is relatively focused anatomically, Parkinson's disease is considered the ideal candidate for brain repair by neural grafting and dopamine neurone transplantation for it has led the way in the neural transplantation research field. In this mini-review, we briefly highlight four important areas of development. First, we describe marked functional benefits up to 18 years after transplantation surgery in patients with Parkinson's disease. This is proof-of-principle that, using optimal techniques and patient selection, grafted dopamine neurones can work in humans and the duration of the benefit exceeds placebo effects associated with surgery. Second, we describe that eventually protein aggregates containing α-synuclein, identical to Lewy bodies, develop inside foetal dopamine neurones transplanted to patients with Parkinson's disease. This gives clues about pathogenetic mechanisms operating in Parkinson's disease, and also raises the question whether neural graft function will eventually decline as the result of the disease process. Third, we describe new emerging sources of transplantable dopamine neurones derived from pluripotent stem cells or reprogrammed adult somatic cells. Fourth, we highlight an important European Union-funded multicentre clinical trial involving transplantation of foetal dopamine neurones in Parkinson's disease. We describe the design of this ongoing trial and how it can impact on the overall future of cell therapy in Parkinson's disease.

Le travail musculaire excentrique est mieux connu aujourd’hui. Il est peu exigeant sur le plan energetique. Il favorise la cicatrisation tissulaire et ameliore la resistance a l’etirement du complexe musculotendineux. Le travail excentrique sous-maximal a vitesse lente renforce l’action inhibitrice des organes tendineux de Golgi sur le tonus musculaire. La realisation de protocoles quantifies et controles sur dynamometre isocinetique tenant compte des dangers potentiels sur le muscle et le tendon peut etre proposee dans de nombreuses indications: lesions musculaires, tendineuses, ligamentaires, renforcement musculaire, instabilite fonctionnelle, hypertonie musculaire et raideur articulaire.

Le desequilibre musculaire est souvent mis en avant dans la physiopathologie des lesions de l’appareil locomoteur et serait un bon indicateur de recuperation apres une lesion ou une chirurgie.

The arrival of new drugs and new therapeutic strategies allowed to reach sustained remission in an increasing number of patients with rheumatoid arthritis. The study of biologic disease-modifying anti-rheumatic drugs (bDMARDs) adaptation strategies is a need to optimize the benefit/risk balance and cost/effectiveness ratio of these molecules. Current recommendations such as EULAR 2016 propose tapering bDMARDs, especially when combined with a csDMARD, when the patient is in remission after stopping persistent glucocorticoids. The analysis of literature comprising 22 studies shows that a bDMARD adaptation is possible in established rheumatoid arthritis when clinico-biological and ultrasound remission is maintained over six months. Priority should be given to a progressive tapering strategy doses controlled by disease activity while maintaining "tight control" to identify and effectively treat a relapse, a retreatment being usually favorable.

Resume Objectif de l’etude La revue de mortalite–morbidite est recommandee par la Haute Autorite de sante (HAS) pour la certification des etablissements de sante. Les comites de retour d’experience elargissent l’analyse aux evenements precurseurs, potentiellement a risque mais n’ayant pas occasionne de complication medicale. Accaparees par leurs tâches habituelles, il n’est pas certain que les equipes hospitalieres soient enclines a mettre en place une analyse systemique des evenements survenus dans leur service. Il leur faut une methode d’analyse facile a mettre en œuvre, suffisamment intuitive et ne necessitant pas d’apprentissage laborieux pour etre acceptee de tous. C’est dans cet esprit que la methode Orion ® a ete developpee. Methode La methode Orion ® est fondee sur l’experience de l’aeronautique, qui a ete un precurseur dans la gestion des risques, tant l’accident d’avion est percu comme inacceptable, bien que la mortalite liee a ces accidents soit extremement faible par rapport celle liee aux erreurs medicales a l’hopital. C’est une methode d’analyse systemique facile a apprendre mais neanmoins rigoureuse, divisee en six etapes : (i) collecter les donnees, (ii) reconstituer la chronologie de l’evenement, (iii) identifier les ecarts, (iv) identifier les facteurs contributifs et les facteurs influents, (v) proposer les actions a mettre en œuvre, (vi) rediger le rapport d’analyse. Les facteurs contributifs et les facteurs influents constituent quatre grandes familles : domaine technique, environnement du travail, organisation et procedures, facteurs humains qui sont essentiels bien qu’ils ne soient pas toujours suffisamment consideres. L’analyse systemique est confiee a un pilote, choisi au sein du pool forme a la methode, qui interroge toutes les categories de personnel hospitalier concernees par l’evenement. Resultats La methode Orion ® est en application dans plus de 400 services hospitaliers francais ou elle soutient aussi bien l’analyse systemique dans les revues de morbi-mortalite que l’analyse des evenements precurseurs dans les comites de retour d’experience. Elle est utilisee, en particulier, dans 145 services de radiotherapie pour soutenir les comites de retour d’experience. Conclusion Grâce a sa simplicite et a sa quasi-intuitivite, la methode Orion ® est un atout pour atteindre les objectifs de l’HAS : mettre en œuvre des revues de morbi-mortalite et des comites de retour d’experience efficaces pour ameliorer la qualite des soins dans les etablissements hospitaliers. En aidant les personnels hospitaliers dans leurs efforts, la methode Orion ® est un outil essentiel contribuant a la securite du patient.

Summary The number of doctors in metropolitan France is set to fall by around 20% by 2020, which will necessarily entail longer waiting times to see a specialist. Telemedicine ensures greater proximity between doctors and patients when the latter leave hospital. For this reason, we have created a cooperation protocol for bringing together a multidisciplinary team around an electronic personalised education programme (ePEP) for patient-monitoring using an electronic blood glucose diary. Given changes in the health system, the goal of cooperation under the terms of article 51 of the Hospital, patients, health, territories (HPST) law is to ensure access for patients to high-quality health care throughout the entire national territories. Skills regarding medical activities have been transferred to paramedical actors in numerous countries, in many cases beginning several years ago. The present diabetes treatment protocol involves patient monitoring using telemedicine (submitted on 2 December 2011). The protocol covers remote treatment of patients on insulin therapy by a multidisciplinary team. To this end, we have trained nurses specialised in the management of such patients, who carry an electronic blood glucose diary. These nurses perform medical acts outside their own area of expertise and normally undertaken by doctors; these are known as specially authorised acts. We have taken into consideration the requirements of both the specially authorised acts and of the telemedicine decree. We decided to insert an electronic version of the acts in the ePEP programme. This software, designed for training purposes, serves as a link between the various members of the multidisciplinary team. Doctors and health auxiliaries have access to patient files at all times. The cooperation protocol is currently undergoing evaluation in the ePEP trial, a multicentre feasibility study that will help define how healthcare is to be reorganised using the personalised education programme by: defining the role of nurses; assessing the benefits perceived by both caregivers and patients; evaluating the impact of ePEP on disease course after 6 months and in the longer term with regard to HbA1c levels, hypoglycaemic episodes, etc. Reorganisation of diabetes care is now well underway. Our management methods are being redesigned and formalised within a protocol in order to improve efficacy without incurring any corresponding increase in costs. We are convinced of the positive role to be played by telemedicine and the involvement of a multidisciplinary team in improving the management of diabetic patients on insulin therapy thanks to more up-to-date organisation of healthcare. We must now discuss the redistribution of costs with the healthcare authorities in order to ensure that such reorganisation is viable!

MicroRNAs (miRNAs) are a class of regulatory RNAs that control the expression of genes critical to cell function. Ectopic expression of miRNAs has been shown to result in genome-wide changes in patterns of gene expression. While the reasons for these global alterations in gene expression patterns have been attributed to the ability of miRNAs to target multiple genes, and/or to induce indirect effects downstream of target genes, the molecular basis of indirect effects of miRNA regulation remains poorly understood. In this study, we demonstrate the potential of miRNAs to regulate other miRNAs. Using miRNA microarray analysis, we show that over 70 different miRNAs are differentially expressed ( ≥1.4 fold, FDR ≤5%) in human ovarian cancer cells after transfection with a single miRNA (miR-7). We present evidence that a major component of miR-7 induced changes in levels of miRNAs is the indirect consequence of miR-7 mediated alterations in levels of protein coding genes ( e.g ., transcription and splicing factors) that exert trans-regulatory control on miRNAs.

Resume Nous rapportons une observation de pubo-discite septique chez un jeune footballeur du centre de formation revelant une septicemie a SAMS ayant necessite une hospitalisation de 12 jours. L’antibiotherapie et les soins ont permis la guerison et le retour a une activite sportive soutenue a trois mois.

Huntington's disease (HD) is the most prevalent polyglutamine expansion disorder. HD is caused by an expansion of CAG triplet in the huntingtin (HTT) gene, associated with striatal and cortical neuronal loss. Central and peripheral metabolic abnormalities and altered insulin-like growth factor-1 (IGF-1) levels have been described in HD. Thus, we hypothesized that restoration of IGF-1-mediated signaling pathways could rescue R6/2 mice from metabolic stress and behavioral changes induced by polyglutamine expansion. We analyzed the in vivo effect of continuous peripheral IGF-1 administration on diabetic parameters, body weight and motor behavior in the hemizygous R6/2 mouse model of HD. We used 9 week-old and age-matched wild-type mice, subjected to continuously infused recombinant IGF-I or vehicle, for 14 days. IGF-1 treatment prevented the age-related decrease in body weight in R6/2 mice. Although blood glucose levels were higher in R6/2 mice, they did not reach a diabetic state. Even though, IGF-1 ameliorated poor glycemic control in HD mice. This seemed to be associated with a decrease in blood insulin levels in R6/2 mice, which was increased following IGF-1 infusion. Similarly, blood IGF-1 levels decreased during aging in both wild-type and R6/2 mice, being significantly improved upon its continuous infusion. Although no significant differences were found in motor function in R6/2-treated mice, IGF-1 treatment highly improved paw clasping scores. In summary, these results suggest that IGF-1 has a protective role against HD-associated impaired glucose tolerance, by enhancing blood insulin levels.

This study examined the role of forebrain N-methyl-D-aspartate receptors (NMDA-Rs) in the promnesiant effects of natural (+) pregnenolone sulfate (PREGS) and its synthetic (−) enantiomer ent-PREGS in young adult mice. Using the two-trial arm discrimination task in a Y-maze, PREGS and ent-PREGS administration to control mice increased memory performances. In mice with a knock-out of the NR1 subunit of NMDA-Rs in the forebrain, the promnesiant effect of ent-PREGS was maintained whereas the activity of PREGS was lost. Memory enhancement by PREGS involves the NMDA-R activity in the hippocampal CA1 area and possibly in some locations of the cortical layers, whereas ent-PREGS acts independently of NMDA-R function.

Previous work conducted at the National Institute of Standards and Technology (NIST) to investigate the field failures of soft body armor containing the material poly(p -phenylene-2,6-benzobisoxazole), or PBO, revealed that this material was susceptible to hydrolysis, and a mechanism of this hydrolysis was proposed. In this work, viscometric estimations of the molar mass of environmentally conditioned PBO are used to support a previously proposed mechanism of PBO hydrolysis. Results with PBO were compared with poly(p-phenylene terephthalamide), or PPTA, which has been used in body armor applications for more than 30 years. Losses in tensile strength were found to correspond to a reduction in molar mass for PBO. This indicates that chain scission due to complete hydrolysis is occurring in this material. Similar trends were observed for PPTA, but the relationship between molar mass reduction and losses in tensile strength was not as evident for this material. Confocal microscopy, mechanical properties measurements, and molecular spectroscopy are used to further investigate the degradation of both PBO and PPTA.